Transparency and advocacy in Health Budgets

Dedication. Commitment. Spirit of inclusion. Desire to see effective and efficient service delivery in the health sector. These are just some of the few terms to describe the recent results of the health budget transparency and advocacy report from Mzimba district, Malawi.

The recent assessment took place between 1st and 3rd August, 2017.

At the phase out of MamaYe-E4A program in the district, there was commitment from the district teams that it will continue to use the skills and knowledge gained to improve the service delivery in the district one way of which was to allocate funds in the district implementation plan for this exercise.

This commitment was fulfilled when the District Commissioner and District Health Officer supported the exercise by ensuring that all the available people were available. This also followed the commitment made by the Parliamentary Committee on Health which endorsed this exercise by calling upon all stakeholders in the district to be responsible in ensuring efficient and improved health service deliver.

The call by the Parliamentary Committee on Health was made during a meeting which MamaYe organised in May this year to advocate for the use of HBTA in the districts for accountability and transparency in local councils. The call was also made following the presentation of the national budget where the health budget only got 9.9% of the national budget.

This commitment and dedication is evidenced with the improvement in budget consultation. The district assessment showed that there was inclusiveness and participation from the grassroots in preparing the health budget.

Paul Kasalu, District Implementation Team focal person, said the process had seen some changes as compared to the very beginning and the last assessment in February this year.

"We are happy now that things have improved as compared to the previous rounds of assessments. There’s great improvement in budget consultation, which has always been one of the challenges in the past. But now we’ve seen the involvement of the grassroots in health budget consultation", said Paul when commenting on the green scored in the domain.

It can be noted that this improvement has come about because of the involvement of the Area Development Committee (ADC) to have their input on the 2017/2018 annual health budget. The ADC comprises of the local chiefs and other local leaders, individuals from various community committees and individuals from the communities.

Services in the health sector have always been not able to achieve the desired expectations of the communities who access the services as they did not have a say on what were the challenges and the needs for a specific health facility. Lack of citizen inclusiveness left some gaps in terms of service delivery to the health facilities and/or misallocation of resources.

Councilor Hestings Chivundu, chairperson of Mzimba Council, also noted that there has been a positive response from officers from different offices in making available information to the people.

"The district has been struggling in the past in terms of accessing information for audit. But after making recommendations in our previous assessments, we see officers providing information for audit. This is a very positive welcome for the district when it comes to budget transparency", said Councilor Chivundu.

The purpose of this exercise is to achieve 100% which is indicated by the color green in all the domains. However, some domains have shown red due to a number of factors which can easily be resolved. For a long time, the district has not been able to function properly with the absence of an internal auditor. However, government has made strides to ensure that each district has an internal auditor which has to be funded by the district council.

The assessment report also points out the district is slightly behind in budget dissemination to the public due to lack of funds for the activity. But it can quickly be pointed out that the district is committed to carry out the activity once funds have been made available.

But has district been able to meet its expectations? This was the question posed to Dr. Lumbani Munthali, Mzimba District Health Officer.

Dr. Lumbani said the district has seen some major improvements at council level including the health sector where it has seen an increase of allocation of resources.

"Ever since the district was introduced to the HBTA by MamaYe, we have seen officers being transparent on how they are utilizing the given resources and in procurement of medical resources and use of finances. There is a lot of commitment from officers which is a positive thing", said Dr. Munthali.

Dr. Munthali further attributed this assessment’s results to positive involvement of the grassroots, which has been the missing link in the past.

As for MamaYe, it is worth celebrating as its work of empowering the communities is still bearing fruits and the name is still living on in the district. This is attributed to the good structures which were laid down in the districts and the good working relationship with different stakeholders to make the health sector vibrant and in the end make pregnancy a joy for mothers.